RESUMO
We report a case of dural arteriovenous fistula at the left transverse sinus and sigmoid sinus(TS-dAVF), which was treated with transvenous embolization(TVE)by direct puncture of the superior sagittal sinus(SSS)under indocyanine green(ICG)fluoroscopic guidance. A 71-year-old woman presented with pulsatile tinnitus and progressive dementia. A left TS-dAVF with retrograde SSS and cortical venous reflux(Cognard type IIb)was demonstrated on cerebral angiography. The left internal jugular vein and distal portion of the right transverse sinus were occluded. We considered that TVE via the femoral vein would be difficult for complete cure. We performed trepanation of the frontal portion of the SSS. The SSS was directly punctured with an 18-G needle under ICG fluoroscopic guidance. We inserted a 4-Fr sheath into the SSS. A microcatheter was navigated into the affected sinus. Coils were placed through the microcatheter. The dAVF was completely diminished. No complications occurred. The patient's pulsatile tinnitus disappeared and dementia improved. Transvenous approach with direct puncture of the SSS under ICG fluoroscopic guidance was a useful approach for the treatment of dAVF when other approaches were difficult.
